In addition to being safer, ultrasound produces better imaging than CT in patients with a pleural-space infection "to sort out who has a loculated empyema that needs VATS [video-assisted thoracic surgery] and who has a nonloculated effusion that generally doesn't need VATS," said Dr.

Among 17 (14%) patients who required surgical intervention, 15 had suppurated lymph nodes requiring incision and drainage, and two developed a loculated empyema requiring thoracotomy and decortication.

In our study loculated pleural effusion were seen in 8 patients, among which 6 cases were loculated tubercular effusion which were treated with steroids and 2 cases were loculated empyema of which 1had minimal loculations removed by medical thoracoscopy while other had moderate loculations referred to higher centre for video assisted thoracoscopic surgery (VATS).

For very sick children with large, loculated empyemas, the current choice of treatment is either intrapleural fibrinolytic therapy via chest tube or video-assisted thoracoscopy (VATS) with pleural debridement.

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